The vascular depression hypothesis proposes that "cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes". African Americans (AAs) have among the highest rates of vascular risk factors in the United States, including hypertension, which is among the highest in the world. AAs also have higher rates of ischemia diseases such as cardiovascular disease, stroke, and vascular dementia. Indeed, vascular dementia has been deemed a "silent epidemic" among older adult African Americans. The proposed study is based on the hypothesis that because of these high rates AAs are at high risk for vascular depression. However, this association has yet to be tested as AAs are underrepresented in mental research in general and clinical trials in particular despite mandates from the NIH that have existed for decades. The goal of this proposal is to establish the feasibility of conducting mental health research in an inner-city, public hospital serving the needs of a primarily African American population. It builds on the community-academic partnership Dr. Sneed and Singh (PIs) have developed over the past four years as part of Dr. Sneed's K23 award. We propose to 1) recruit twenty AAs (age >=50) per year with major depression for a one year study involving acute antidepressant treatment, repeat neuropsychological testing, and pre-post structural MRI;2) demonstrate an 80% retention rate in the acute treatment phase;and 3) demonstrate a 75% retention rate among patients completing the acute treatment phase at 1-year follow-up. The community-academic partnership, focus on a high risk population, and incorporation of advanced imaging techniques represents an innovative next step in the study of vascular depression. The pilot data generated by this feasibility study will support a subsequent R01 examining acute treatment response, relapse rates, and progression of cognitive impairment and white matter lesion burden in AAs with vascular depression. Furthermore, this proposal meets each of NIMH's strategic objectives: 1) develops an integrative understanding of brain- behavior processes underlying vascular depression;2) characterizes the developmental trajectory to determine when, where, and how to intervene;3) develops a community- academic partnership;and 4) meets the needs of an underserved and understudied population in an inner city, public hospital setting;and ultimately (if funded), promotes the public health impact of NIMH-sponsored research. PUBLIC HEALTH RELEVANCE: African Americans have the highest rates of hypertension in the world, and not surprisingly, higher rates of cardiovascular disease, stroke, and vascular dementia. Given that the number of African American older adults is expected to increase fivefold by 2050, the social and economic implications of being at high risk for vascular depression could be staggering. Building on a community-academic partnership model, the proposed study addresses this important public health need by establishing the feasibility of conducting mental research in an inner-city, public hospital setting.